Individual provider Active NPI

Eric C Gebhart, B.S., CSAC

  • Addiction (Substance Use Disorder) Counselor
  • New Glarus, WI
National Provider Identifier
1821245192
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
15274-132 Issued in WI
Practice address
1307 State Road 69
New Glarus, WI 53574-9328
Phone
(608) 527-2426
Fax
(608) 527-1939
NPI assigned
Aug 19, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 15274-132 WI Primary

Addresses

Primary practice location

1307 State Road 69
New Glarus, WI 53574-9328

Mailing address

1307 State Road 69
New Glarus, WI 53574-9328
Phone (608) 527-2426

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address eric@lifesabeachcounselingllc.com
Direct Messaging Address eric@lifesabeachcounselingllc.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
15274-132WIMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Life'S a Beach Counseling LLC Addiction (Substance Use Disorder) CurrentSince Oct 4, 2020 Accepting new patients
County of Green PastSince Jul 1, 2012 Accepting new patients

Locations

1307 State Road 69
New Glarus, WI 53574
Phone (608) 527-2401

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1821245192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 STATE ROAD 69",
            "city": "NEW GLARUS",
            "state": "WI",
            "postal_code": "535749328",
            "telephone_number": "608-527-2426",
            "fax_number": "608-527-1939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 STATE ROAD 69",
            "city": "NEW GLARUS",
            "state": "WI",
            "postal_code": "535749328",
            "telephone_number": "608-527-2426",
            "fax_number": "608-527-1939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEBHART",
        "first_name": "ERIC",
        "middle_name": "C",
        "credential": "B.S., CSAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-19",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15274-132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eric@lifesabeachcounselingllc.com",
            "affiliation": "N",
            "address_1": "1307 State Road 69",
            "city": "New Glarus",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535749328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eric@lifesabeachcounselingllc.com",
            "affiliation": "N",
            "address_1": "1307 State Road 69",
            "city": "New Glarus",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535749328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Glarus, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.